Provider Demographics
NPI:1154562825
Name:WILLIAMSON, KRISTIN M (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20310 EMPIRE AVE STE A103
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-5723
Mailing Address - Country:US
Mailing Address - Phone:541-604-8255
Mailing Address - Fax:541-706-9440
Practice Address - Street 1:20310 EMPIRE AVE STE A103
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-5723
Practice Address - Country:US
Practice Address - Phone:541-604-8255
Practice Address - Fax:541-706-9440
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist